Attention Deficit Disorder - Print Version : Online Reference for Health Concerns

Attention Deficit Hyperactivity Disorder

What is ADHD?

If you or your child has just been diagnosed with attention deficit hyperactivity disorder (ADHD), don't despair. While in the past, a frightening regimen of powerful pharmaceuticals was used for this disorder, newer findings in nutrition and wellness are providing less invasive options for treating and preventing ADHD. ADHD is a condition marked by an inability to pay attention, concentrate, or complete tasks, sometimes accompanied by hyperactivity that occurs in both adults and children. Previously it was called simply attention deficit disorder (ADD), but clinicians now refer to this disorder as ADHD and differentiate three types: inattentive, hyperactive-compulsive, and combined. In the past, ADHD has been called hyperkinetic syndrome and even minimal brain syndrome, reflecting our poor understanding of this condition (Sangare 2000). Whatever the name, the prevalence of ADHD is soaring. According to the American Psychiatric Association's Diagnostic & Statistical Manual-IV-TR (DSM-IV), 3-7% of children currently have ADHD, with boys outnumbering girls 3 to 1. In addition, a study finds that 1-6% of adults meet formal diagnostic criteria for ADHD (Wender et al. 2001).

Obtaining a Diagnosis
The first step in deciding whether you or your child has ADHD is seeing a health professional qualified to make a diagnosis. Unfortunately, this can be a tricky process. ADHD has been called a "fad" and the condition "du jour" because so many people are suddenly "discovering" they have it due to the over-diagnosis of this disorder. One reason is that few health professionals can agree on just what ADHD is and fewer still follow the diagnostic criteria already established for it. Often diagnoses are made by a single health professional without adequate training in behavioral science. Since clear biochemical, genetic, and anatomical markers of ADHD are not yet available, diagnosing ADHD requires a detailed medical history along with observations and is best accomplished using a team approach.

According to the DSM-IV, a person needs to have first experienced ADHD in a persistent and disabling manner for 6 months before age 7 in order to qualify as having this condition. However, many people are diagnosed with ADHD without any early history of the ailment.

In addition, many other conditions can cause symptoms that mimic ADHD. Many children who have been sexually abused show symptoms that can often be confused with ADHD. For example, one study found that physical or sexual maltreatment and post-traumatic stress disorder (PTSD) (hyperarousal/hypervigilance) symptoms overlapped with those of ADHD (Ford et al. 2000). ADHD is also frequently confused with bipolar disorder but differs substantially in that bipolar children suffer from hypersexuality and parental conflicts that do not occur in ADHD (Geller et al. 2000).

Behavioral Signs
Despite the many difficulties in obtaining an accurate diagnosis, there are increasingly clear behavioral criteria for ADHD. Behavioral tests used to measure ADHD include assessments of how well patients can concentrate and process information because many ADHD children cannot think abstractly or isolate pieces of information and combine them into whole ideas, instead thinking in whole pictures. Here are some current signs to watch out for in both children and adults:

Motor Problems: Visual attention loss, hyperactivity, altered facial expression (such as oversized and sustained smile), abnormal motor skills, excessive fidgeting, and constant hand and leg movements (Kuhle et al. 2001)
Attention Problems: Procrastination, impulsive talking, difficulty starting or finishing tasks, reading disorders, low educational level, dependency on a rigid schedule to function, and extreme disorganization (Rasmussen et al. 2000)
Mood Disorders: Bursts of anger, frequent interrupting, inappropriate behavior in social situations, anxiety, depression, feelings of hopelessness, and low self-esteem
Addictions and Alienation: Drug addictions, alcohol abuse, criminal offenses, and difficulty maintaining a career or relationships (Mannuzza et al. 2000)

Physical Markers
Some exciting recent research is beginning to uncover the biochemical and genetic changes found in ADHD:

Low Neurotransmitters: According to a fascinating theory from evolutionary medicine called the "reward deficiency syndrome," due to genetic defects some people do not produce sufficient neurotransmitters, particularly dopamine, in response to pleasure drives for eating, love, and reproduction. As a result they seek dopamine release and sensations of pleasure via junk foods and drugs, such as sugar, alcohol, cocaine, methamphetamine, heroin, nicotine, marijuana, and by compulsive activities, such as gambling, eating, sex, and risk-taking behaviors (Comings et al. 2000). Other researchers support this theory, noting low levels of serotonin are linked to ADHD and are associated with increased aggression in humans and other animals (Mitsis et al. 2000). As we'll see below, nutritional and wellness strategies to increase these neurotransmitter levels naturally offer attractive treatment options for ADHD.
Genetic Defects: Following the rewards deficiency syndrome theory and the fact that stimulant medications act primarily by altering levels of dopamine, numerous genetic studies of ADHD have looked at defects in genes that control dopamine receptors. One allele of the dopamine D2 receptor gene is associated with alcoholism, drug abuse, smoking, obesity, compulsive gambling, and several personality traits (Comings et al. 2000). Other researchers support these findings, suggesting that defects in dopamine receptors genes are implicated in ADHD (Sunohara et al. 2000).

Conventional TreatmeNTS

When you or your child are first diagnosed with ADHD your primary care health professional will most likely suggest stimulant medications such as Ritalin (methylphenidate), Dexedrine (dextroamphetamine), Desoxyn (methamphetamine), Cylert (pemoline), or Adderall. Adderall is a mixture of four different amphetamine salts and is considered the current drug of choice because it remains in the body longer than Ritalin and causes fewer ups and downs. Unfortunately, Adderall has the same side effects as other stimulant drugs used for ADHD, including drug interactions, insomnia, dizziness, headache, loss of appetite, growth impairment, tics, stomach aches, and zombie-like behavior (PDR 2002).

Stimulants for ADHD work by suppressing all spontaneous behavior. Chimps cease any self-generated behavior, while in humans, play, socializing, and exploration all decline (Breggin 1999). Stimulant medications are used for ADHD because people with this disorder have slower brainwaves in frontal and polar regions of the brain than people without it (Chabot et al. 2001). These drugs show short-term effectiveness for control of overactivity, impulsivity, inattention, aggressiveness, and low academic productivity but no long-term control. Long-term studies since the 1960s, using markers such as finishing high school, finding a job, and avoiding drugs, alcohol, or arrest, have found that children who took stimulants for ADHD did no better later in life than those who did not (Mannuzza et al. 2000).

Further, as already noted, stimulant drugs come with some severe side effects. For example, neurological side effects including insomnia, anxiety, social withdrawal, fatigue, passivity, emotional flatness, depression, and sadness due to neurotransmitter disturbances can all occur from using stimulant medications. Also, headaches, facial tics, stereotypical behavior (meaningless, compulsive activities), and obsessive-compulsive behavior (endless repetition of activities) can occur (Kooij et al 2001). A vicious cycle of medication occurs in conventional ADHD treatment in which antidepressants, sedatives, and mood stabilizers are prescribed to control emotional disturbances caused by initial stimulant medication.

Eventually, children as young as 10 years old can develop bipolar disorder due to the medications themselves. For example, one study found that bipolar adolescents with a history of stimulant exposure prior to the onset of bipolar disorder had an earlier age at onset than those without prior stimulant exposure. The study also found that bipolar adolescents treated with at least two stimulant medications were of a younger age at onset compared with those who were treated with one stimulant (DelBello et al. 2001). Other major possible side effects from stimulants include growth impairment due to decreased appetite, cardiovascular problems such as increased blood pressure, and liver damage.

When stimulants are not effective, tricyclic antidepressants such as Tofranil may be given. This class of drugs is usually prescribed to treat major depression. Tricyclic antidepressants work by increasing levels of the brain chemicals serotonin and norepinephrine that affect mood, emotions, and mental state.

Drug Addictions
Among the most troubling side effects of stimulant medications and possible cofactors in ADHD is an increased risk of drug addictions. The explosion of ADHD diagnoses and abuse of powerful stimulant drugs among children has the Drug Enforcement Agency (DEA) and National Institute of Mental Health (NIMH) concerned (Zito et al. 2000). Here are some of the major drug addictions that can occur with ADHD and stimulant medications:

Alcoholism. One study notes that indicators of ADHD are found among alcoholics, which may indicate high rates of ADHD in their earlier years of life. The study also points to the strong association between addiction and ADHD. Both disorders share clinical aspects and relevant biological markers, and for both, alterations in the same cerebral systems occur (Ponce Alfaro et al. 2000).
Smoking. A study by Kent et al. (2001) notes that nicotine addiction is more likely in people with ADHD since nicotine promotes the release of dopamine and has been shown to improve attention in adults with ADHD. Another study notes that ADHD is linked to cigarette smoking in children, and mothers who smoke are more likely to have children with ADHD (Levin et al. 2001).
Cocaine. Mothers who use cocaine are more likely to give birth to children with ADHD. A study of urban African-American children (Bandstra et al. 2001) suggests prenatal cocaine exposure can lead to long-lasting disruption of the brain systems regulating arousal and attention.
Ritalin Abuse. The DEA classifies methylphenidate and amphetamine as Schedule II drugs (those with the very highest potential for addiction and abuse), a category that also includes methamphetamine, cocaine, and the most potent opiates and barbiturates. Methylphenidate is derived from the same family as cocaine and gives a similar, brief 4-hour high (Vastag 2001), making it an increasingly popular recreational drug. The number of students who abuse Ritalin has exploded. In one survey at a public liberal arts college in Massachusetts, more than 16% of the students reported they had tried methylphenidate recreationally, and 12.7% reported they had taken the drug intranasally, about the same figures found for cocaine and amphetamine use (Babcock et al. 2000). Ritalin tablets are often taken crushed and snorted like cocaine for a quick burst of energy. Emergency room admissions due to Ritalin abuse have also climbed rapidly, and severe side effects such as hyperthermia, hypertension, strokes, seizures, and death are often observed.

Nonstimulant Drugs
To help reduce the harsh side effects of conventional treatments for ADHD, some alternative nonstimulant drugs are being developed. Be sure to check with your primary care health professional to see if some of these drugs might be right for you:

Atomoxetine is an investigational, nonstimulant drug that is thought to act by blocking norepinephrine transport in the brain and appears to be safe and well tolerated (Michelson et al. 2001).
Gabapentin is an anticonvulsant drug released in the United States in 1993 for use as adjunctive therapy in refractory partial epilepsy and is sometimes used for bipolar adults. The drug appears to have a good safety profile (Hamrin et al. 2001).
Bupropion appears to be effective and well tolerated in adolescents with ADHD and depression (Daviss et al. 2001).
Modafinil is a wake-promoting yet nonstimulant drug that is helpful in adults with ADHD (Taylor et al. 2000).
Tomoxetine is a novel noradrenergic-specific (stimulated or released by norepinephrine) antidepressant; Aricept (donepezil), cholinergic (acetylcholine releasing) cognitive enhancing anticholinesterase inhibitors; and ABT-418, a novel nicotinic analogue, also look promising (Biederman et al. 2000).

Complementary StrategiES

Given the perils of conventional approaches to ADHD and the frightening problems that can arise if untreated, it is fortunate that a wide variety of less invasive, safer, and effective approaches to ADHD are currently available. These include mind-body approaches, environmental strategies, exercise, dietary changes, and supplements.

Behavioral Medicine
A good first step in addressing ADHD nonpharmaceutically is using a few key behavioral techniques:
Establish Routines: Setting routines is an important component of treatment for people with ADHD and should include set times for bed, play, bathing, TV, dinner, school, and homework.
Maintain Eye Contact: People with ADHD should be encouraged to look people in the eyes when spoken to and acknowledge what was said.
Practice Meditation: Techniques to enhance focus and attention such as meditation are useful. One therapy called the interactive metronome improves attention, motor control, and selected academic skills in boys with ADHD. An interactive metronome works by combining a computer with a metronome to help the user match his or her timing during tapping exercises to that of a reference tone (Shaffer et al. 2001).
Avoid Information Overload: Information technologies are creating attention disorders among business executives who have to handle vast amounts of information (Davenport et al. 2000). Because people with ADHD have slow brain processing speeds, they perceive time as moving more quickly and have difficulty processing the glut of new information all around us (Goddard 2000).
Try Biofeedback: Biofeedback electroencephalograph (EEG) training works to teach children with ADHD to enter a calm, alpha brainwave state and use different neurological pathways, which improves impulse control, increases attention, and allows more efficient processing of information. Biofeedback may be particularly effective for ADHD because people with this disorder have slower brainwaves in frontal and polar regions of the brain than people without it, which explains the use of stimulant medications (Chabot 2001). Biofeedback has also been used to treat alcoholism and appears to work so well that many children with ADHD can stop their drug therapies using this technique. Typically 20-40 sessions are required.

Exercise
The next strategy to try is using an exercise routine. Exercise is a rather obvious but overlooked way to help control the symptoms of ADHD. One study looked at the rate of spontaneous eye blinks, the acoustic startle eye blink response (ASER), and motor activity in children with ADHD. Researchers subjected subjects to a treadmill exercise bout at 65-75% VO2 max (the maximum oxygen uptake by the lungs). The results suggest vigorous exercise can improve symptoms of ADHD via dopamine release (Tantillo et al. 2002). A current position paper on exercise and children by the American Heart Association ( www.americanheart.org/presenter.jhtml?identifier=4596 ) recommends 30 minutes of moderate intensity activity on most days of the week and a minimum of 30 minutes of vigorous activity 3-4 days a week. This level of activity is shown to help prevent a wide variety of behavioral and physical disorders in children.

Environmental Health
While a bit more difficult to perform than mind-body or exercise protocols, a thorough evaluation and clean-up of environmental toxins should be made immediately upon diagnosis with ADHD. Very current research suggests that environmental chemicals, molds, fungi, and neurodevelopmental toxins such as heavy metals and organohalide pollutants are possibly linked to ADHD. Changes in thyroid function may be one reason environmental toxins can affect ADHD (Kidd 2000). One review notes parallels between the features of ADHD and the behavior of monkeys exposed developmentally to lead or polychlorinated biphenyls (PCBs) (Rice 2000).

Finally, according to an article in Life Extension Magazine (O'Brien 2001) ( http://www.lef.org/magazine/
mag2001/mag2001_5.html ), mercury vapor from dental amalgam fillings can cause many of the symptoms of ADHD. Mercury toxicity in mothers can cause learning disabilities, autism, and ADHD in unborn children by fast placental transfer and could explain the explosion in learning and behavioral problems since World War II when mercury was first used in dentistry. Symptoms of mercury toxicity include irritability, anxiety, restlessness, memory and attention problems, confusion, and loss of coordination.

Diet
Specific dietary tactics including avoiding allergenic foods, reducing sugar intake, and increasing consumption of foods rich in vitamins and minerals have been shown to help control ADHD in children and adults.

Allergenic Foods
Food allergies are a common, though controversial area of concern for people with ADHD. Oligoantigenic (few-foods) diets for ADHD have convincing double-blind evidence of efficacy (Egger et al. 1985); however, they appear to be most effective in children, not adults (Arnold 2001). In brief, a nonallergenic diet involves eliminating many foods considered allergenic. The theory that certain foods are allergenic and cause health problems such as ADHD is based on the premise from evolutionary medicine that foods which are the most genetically altered from wild foods on which we evolved are the most likely to cause allergies.

The most widely known proponent of the allergenic theory of ADHD is Benjamin Feingold, M.D., who suggested that food additives in particular are to blame, including artificial colors, flavor enhancers, thickeners, bleaching and anticaking agents, and preservatives. Research has indeed shown that food dyes can cause irritability, restlessness, and sleep disturbances (Rowe et al. 1994) while other food additives can cause similar symptoms (Boris et al. 1994). Other commonly allergenic foods and food products, such as wheat, oranges, soy, milk, corn, and eggs, are also often eliminated. An elimination diet involves systematically eliminating one possible food allergen at a time to see whether a specific food is causing ADHD.

Sugar
Sugar is certainly the single most damaging food linked to ADHD and a variety of other disorders. The sudden release of insulin and drop in blood glucose caused by refined sugar intake (reactive hypoglycemia) rapidly raises adrenaline, causing a fight or flight response and the aggressive behavior, hyperactivity, and attention problems found in ADHD (Wender et al. 1991). Children with ADHD also experience abnormal rhythms in regard to the stress hormone cortisol, which often occurs in people who have problems metabolizing carbohydrates (Kaneko et al. 1993; Wolraich et al. 1994). Girardi et al. (1995) found that, upon sugar feeding, people with ADHD release only half the catecholamines (adrenal hormones such as norepinephrine and epinephrine that counterbalance a rapid drop in glucose due to high insulin) as controls. Girardi et al. (1995) also noted that PET scans of children with ADHD showed much less brain activity due to insufficient glucose and tests indicated worse cognitive performance.

In addition, many of the children with ADHD became more hyperactive following the glucose intake in an effort to trigger their adrenal glands to produce more catecholamines. Finally, the most recent studies also show that ADHD is linked to catecholamine dysfunction and energy disorders in brain neurons because it is improved by medications that enhance catecholamine function (Todd et al. 2001). The results of this and other studies on sugar and ADHD emphasize the importance of well-balanced meals rich in protein and complex carbohydrates, which raise catecholamine levels and control fluctuations in glucose.

Poor Nutrition
Optimal levels of certain nutrients, which are often hard to obtain in a normal diet, are crucial in preventing and treating ADHD. In addition, deficiencies of certain nutrients during the critical period of brain formation can lead to permanent damage that may be linked to ADHD in later life. Since 90% of total brain growth takes place during the first 3 years of life, it is essential to provide high-quality building blocks, through diet or supplementation, during this period. Poor nutrition affects the development of the brain during this period and can have damaging effects that may lead to ADHD (Scrimshaw et al. 1968). Early studies show that children who lack optimal amounts of essential nutrients experience reduced attention span and intellectual ability (Crook 1980). Unfortunately, a U.S. Department of Agriculture (USDA) dietary survey of 3300 U.S. children and adolescents showed that less than 1% meet the recommended daily requirements for the five food groups and 16% do not meet any of the requirements (Munoz et al. 1997).

Nutritional Supplements
Numerous studies suggest that people with ADHD may be deficient in specific nutrients and that in some cases, supplementation may improve some of the symptoms of the disorder.

Essential Fatty Acids
Essential fatty acids (EFAs) are the most important nutrients to consider in the battle against ADHD. For example, one study found that a deficiency of long-chain polyunsaturated fatty acids is linked to ADHD (Richardson et al. 2000a; 2000b). Another study found that deficiencies in highly unsaturated fatty acids (HUFAs) cause the symptoms of ADHD. After 12 weeks of supplementation with HUFAs, researchers found major improvements in ADHD-related symptoms in children with specific learning difficulties such as dyslexia (Richardson et al. 2002).

Some ADHD diagnoses might be EFA deficiencies in disguise. One study found that ADHD patients reporting symptoms indicative of EFA deficiency had significantly lower levels of plasma arachidonic acid (AA) and docosahexaenoic acid (DHA) than did ADHD patients without these symptoms or controls. In this study patients with low omega-3 fatty acid levels had more temper tantrums and learning, health, and sleep problems than those with high levels of these fatty acids (Burgess et al. 2000). DHA supplementation has proven helpful in people with ADHD (Voigt et al. 2001). DHA can be found in deep-sea, cold-water fatty fish, such as salmon, herring, and tuna; sea vegetables (which is where fish obtain DHA); and micro-algae. Supplements are derived from these sources. Linoleic and linolenic acids found in products such as flax and hempseed oil are precursors of DHA and AA, but their manufacture in the body can be blocked by saturated and trans fats.

Phosphatidylserine
Phosphatidylserine (PS) is a natural extract of lecithin and a phospholipid that is vital to brain cell structure and function. Phospholipids are molecules with an amino acid component and a fatty acid component which are found in every cell membrane in our bodies. ADHD, dyslexia, dyspraxia, and autism are now considered "phospholipid disorders" because phospholipids are so important in the natural history, symptoms, and prevalence of these conditions which aggregate within families (Richardson et al. 2000a; 2000b). PS plays an important role in neurotransmitter systems, brain metabolism levels, and maintaining nerve connections in the brain. PS helps lower cortisol levels that are increased in chronically stressed individuals and improves brain cell membrane fluidity, which helps with dementia and depression. While there is little experimental data available using PS for ADHD as yet, its many cognitive benefits suggest it should prove extremely helpful (Jorisse et al. 2001).

Choline
Choline, a precursor for acetylcholine, is another important supplement for ADHD. One study found that the genetic and structural indicators of poor memory in the brain (called developmental instability) correlated with lower concentrations of creatine-phosphocreatine (Cre) and choline-containing compounds, whereas Cre and N-acetyl-aspartate correlated with good memory. This finding may be due to differences in frontal lobe energy metabolism (Yeo et al. 2000).

DMAE
Dimethylaminoethanol (DMAE) is naturally present in the brain and found in such "brain foods" as anchovies and sardines. DMAE accelerates the brain's synthesis of acetylcholine. As a supplement for ADHD, it has been used effectively to treat such symptoms as shortened attention span, hyperactivity, learning and behavior problems, reading and speech difficulties, and impaired motor coordination (Dean et al. 1990).

Amino Acids
Adequate protein intake is essential for manufacture of neurotransmitters in the brain from amino acids, which is crucial for reducing ADHD symptoms. Children with ADHD are often deficient in L-glutamine, a precursor for gamma-aminobutyric acid (GABA), a neurotransmitter that calms the mind and may play a role in hyperactivity. One study suggests that ADHD is caused by a deficiency of glutamate, with prefrontal brain regions being especially affected, while obsessive-compulsive disorder is caused by too much glutamate (Carlsson 2000). Another review found that amino acid supplementation for ADHD is most effective in the short term (2-3 months), but long-term benefits and ideal dosages have yet to be determined (Arnold et al. 2000).

Vitamins
Vitamins may help prevent and treat ADHD by protecting the nervous system from free radical attack and supporting the body in making neurotransmitters. Sociologists Schoenthaler et al. (2000) found that multivitamin supplementation of school-age children (ages 6-12) with behavioral problems such as ADHD helps control antisocial behaviors such as swearing, vandalism, assault, and refusal to work. Previous studies by these researchers have shown similar findings among prisoners, ages 13-26. Of all the vitamins, B vitamins are particularly important for fighting ADHD because they assist brain enzymes in using carbohydrates for energy, help synthesize neurotransmitters such as serotonin, dopamine, and GABA, and form myelin, which shields connections between neurons. A deficiency of B1 (thiamin) causes nervousness, irritability, and increased sensitivity to noise. B6 deficiency causes low levels of neurotransmitters such as serotonin, which are found in hyperactive children (Bhagavan et al. 1975). Vitamin C is also important for making neurotransmitters.

Minerals
Select minerals are especially effective in preventing and controlling ADHD. Zinc is an important cofactor for production of neurotransmitters, prostaglandins, and melatonin and for metabolism of dopamine and fatty acids, all of which are involved in ADHD. One study showed that zinc and fatty acids were decreased in children with ADHD (Bekaroglu et al. 1996). A more recent study examined zinc, D-amphetamine, and Efamol (evening primrose oil, rich in gamma-linolenic acid) in subjects with and without ADHD, using hair, red cell, and urine measurements to assess zinc levels. Efamol supplementation was beneficial only in those with borderline zinc levels. This suggests that Efamol works by improving zinc deficiency. Zinc deficiency in people with ADHD may also be the reason for poor responses to stimulant therapy (Arnold et al. 2000). Magnesium levels appear to be low in patients with ADHD, and supplementation has reduced hyperactivity (Starobrat-Hermelin et al. 1997). A dosage of 200 mg daily has been used in most studies. Finally, iron deficiency has been implicated in ADHD and is a fairly common problem in children.

Herbs
Numerous herbs are shown to help prevent and control ADHD by improving blood flow to the brain and nervous system, reducing stress, and removing toxins from the body.

Hypercoagulation is a disorder in which excess coagulation of the blood leads to hypoxia, or low oxygen, and death in tissues. In newer studies, hypercoagulation has been linked to immune system function and numerous seemingly unrelated diseases such as cancer, heart disease, and cognitive disorders such as ADHD. To help control hypercoagulation, an array of hypocoagulant supplements including curcumin (turmeric extract), ginger, and ginkgo should be used (Liao 2000). In ADHD, hypercoagulation is more of a concern in adults than children.

A study of a combination herbal product containing American ginseng extract, Panax quinquefolium (200 mg), and Ginkgo biloba extract (50 mg) was tested for its ability to improve the symptoms of ADHD. Between 31-74% of patients taking the medication experienced improvements in various indicators including anxiety, shyness, social problems, hyperactivity, and impulsiveness (Lyon et al. 2001). Fish oil, enzymes such as bromelain and Wobenzym, and massage have also been shown to lower blood viscosity.

Interestingly, methylphenidate (Ritalin) appears to work like ginkgo and other herbs by increasing regional cerebral blood flow (Kim et al. 2001). Structural studies show that in children with ADHD there is decreased blood flow and energy use in the prefrontal cortex and striatum. One possible result is a decrease in volume of certain brain areas in people with ADHD. The brain regions responsible for attention, including the anterior corpus callosum, right anterior white matter, and cerebellar areas, are actually smaller in people with ADHD (Paule et al. 2000). Another study indicates there are left hemispheric white matter deficits due to dysmyelination and gray matter deficits in the right hemisphere in ADHD patients (Overmeyer et al. 2001).

Stress-reducing herbs, such as passion flower, valerian, or lemon balm, are recommended because stress contributes to ADHD (Berdonces 2001). Finally, detoxifying herbs and algae, such as spirulina, have also been suggested for ADHD. Spirulina may help ADHD by removing aluminum, carbon tetrachloride, and other toxins from the body (Torres-Duran et al. 1998; Vadiraja et al. 1998). Sevulla et al. (1995) found an 81% improvement in academic scores when children took 1 gram of spirulina every day for 6 months.

Hormone Imbalances
In adults, certain prohormone supplements such as dehydroepiandrosterone (DHEA) may help control or prevent ADHD. ADHD is associated with low blood levels of neurosteroids such as DHEA, its principal precursor pregnenolone, and its principal metabolite dehydroepiandrosterone-sulfate (DHEA-S). Conversely, higher blood levels of these neuro-steroids are associated with fewer symptoms of ADHD (Strous et al. 2001). Prohormone supplements are not safe for children. However, hormone-controlling drugs may sometimes help in cases of child ADHD. For example, some research suggests that children ages two to seven with ADHD and learning disabilities have high levels of thyroid hormone and thus thyroid hormone lowering drugs, such as neomercazole, may be effective. Thyroid treatment is effective in the presence of documented thyroid abnormality only (Arnold 2001).

SUMMARY

Conventional treatments for ADHD have included psychostimulants such as Ritalin, Dexedrine, and Desoxyn that suppress spontaneous behavior. Research has shown that the use of these drugs provides very few if any positive long-term benefits. In addition, serious physical and emotional side effects are seen in children while taking these powerful medications. New nonstimulant drugs with fewer harsh side effects are currently being introduced as a safer alternative. Allergies from genetically altered food and additives may also trigger symptoms of ADHD and hyperactivity. An elimination diet that will pinpoint possible food allergens is recommended. Hormone imbalances such as an overactive thyroid should be checked in both adults and children with ADHD.

Complementary strategies such as behavior modification, physical exercise, and avoidance of environmental toxins can be a safe and effective approach in managing ADHD. Poor nutrition early in life can have long-term effects on brain development and functioning. Many adults and children with ADHD are lacking in vital nutrients. Research has shown that proper supplementation can significantly reduce the severity of their symptoms. Nutritional supplements and appropriate dosages for children should be physician-supervised based on total medical treatment, age, and body size.

Essential fatty acids: DHA from fish oil is the most important essential fatty acid for the brain. The recommended daily dose of DHA is 1000-2000 mg daily for adults and 500-1000 mg daily for children. For those who cannot afford DHA fish oil, flax oil may work because it usually converts in the body to DHA (and EPA). Flax oil liquid may also be easier for children to take than DHA capsules.
Vitamins and minerals: Life Extension Mix and Children's Formula Life Extension Mix are ideal sources of many vitamins and minerals such as vitamins B and C, zinc, and magnesium, vital in maintaining the health of neurotransmitters. Follow dosing recommendations on the product label.
Choline helps to restore low levels of acetylcholine in the brain. A suggested dose is 1000-6000 mg daily to boost memory and concentration. However, it is difficult to obtain enough choline in dietary supplements. Adults can obtain high potencies of choline and other nutrients for the brain in a product called Cognitex. Children may have to rely on choline powders with an unpleasant taste. DMAE is a more convenient way for some children to obtain acetylcholine precursors.
DMAE helps accelerate synthesis of acetylcholine. Adults: Begin at a low dose of 100 mg in the morning and 100 mg in the evening on an empty stomach, gradually building up to 500 mg twice daily. Some individuals do well remaining at a low dose because side effects such as headaches, muscle tenseness, and insomnia may occur at higher doses. Children: half the recommendation for adults.
Phosphatidylserine is a phospholipid that is vital to neuronal functioning and brain metabolism. Adults: 100-400 mg daily for people with neuronal dysfunction. Children: 100 mg daily.
Amino acids: Be sure to eat well-balanced meals with complete protein. Adults: glutamine, 1 or more grams daily; and GABA, 1/8-1/4 tsp daily. Children: glutamine, 250-500 mg daily; and GABA, 1/8 tsp daily.
Herbs such as ginkgo and ginseng will improve blood flow to the brain and help remove toxins from the body. Life Extension Herbal Mix enables one to obtain high potencies of brain-boosting herbal extracts along with some acetylcholine precursors. The advantage of Life Extension Herbal Mix is that it comes in a powder form that some children will find palatable. Adults: 1 tbsp daily. Children: 1 tsp daily.
Theanine helps calm the nervous system without sedation. Adults: 300-400 mg daily. Children: 100-200 mg daily.
DHEA: Low levels of the neurosteroid DHEA are associated with ADHD. Blood testing is highly recommended first to eliminate the possibility of hormone-related cancers and to establish a baseline for supplementation. DHEA supplementation is not appropriate for children.
Mind-body techniques: Try massage, biofeedback, meditation, and routine setting. Avoid information overload.
Exercise: The American Heart Association recommends 30 minutes of moderate intensity activity on most days of the week and a minimum of 30 minutes of vigorous activity 3-4 days a week. This level of activity is shown to help prevent a wide variety of behavioral and physical disorders in children.
Environmental health: Avoid pollutants including PCBs and heavy metals (often found in fish). Buy organic foods whenever possible and use air and water filters.
Diet: Try allergy testing and a Feingold-type elimination diet. Avoid sugar.